MED SURG 3 NURS 480 Advanced Med Surg Final Review 2024 A+ Grade.

MED SURG 3 NURS 480 Advanced Med Surg Final Review 2024 A+ Grade. NURS 480 Final Exam Review: 1. If I push the endotracheal tube too far, where will it go? Right lung  so we will have absent breath sound in the left lung. Right bronchus intubation 2. TIPS (Transjugular Intrahepatic Portosystemic Shunt): in Portal hypertension to decrease the gastric varices bleeding by decreasing the portal venous pressure a. This procedure reduces the portal venous pressure and decompresses the varices, thus controlling bleeding 3. Difference between embolic and thrombotic stroke: how do you explain it to a patient in a way that they understand? a. Ischemic Stroke: i. Inadequate blood flow to the brain from partial or complete occlusion of an artery  causes ischemia distal to the occlusion ii. 80% of all stroked are ischemic strokes  usually thrombolytic should work iii. It can be thrombotic or embolic iv. Atherosclerosis, a hardening and thickening of arteries, is the major cause of ischemic stroke. It can lead to thrombus formation and contribute to emboli. v. Thrombotic stroke: clot formation there vi. Embolic stroke: it means it came from somewhere else 1. Thrombotic and embolic are almost the same except that embolic means the blood clot came from somewhere else in the body  you had clot in your carotid and it went to your brain b. Thrombotic stroke: i. Thrombosis occurs in relation to injury to a blood vessel wall and formation of a blood clot. ii. Result of thrombosis or narrowing of the blood vessel iii. Most common cause of stroke iv. Lacunar strokes are typically asymptomatic  lacunar infarcts can be seen in MRI 1. When we do the MRI in 60-70 years old patient we may see minor infarcts  it means the patient had lacunar strokes but it was totally asymptomatic c. Embolic Stroke: i. Occurs when an embolus lodges in and occludes a cerebral artery ii. Second most common cause of stroke iii. Rapid occurrence of severe clinical symptoms (loss of consciousness or neurologic deficits) iv. Onset is usually sudden and may or may not be related to activity v. Patient usually remains conscious, although he may have a headache vi. Basically patient has big clot that immediately starts to travel to the brain  symptoms: dysarthria, weakness vii. We will not miss the embolic stroke 4. If a person has anaphylactic shock, what is the best way to figure out if the patient is doing ok? What is the first thing you want to check? Airway, Oxygen saturation - Anaphylactic shock can lead to respiratory distress due to laryngeal edema or severe bronchospasm, and circulatory failure from the massive vasodilation.8 The patient has a sudden onset of symptoms, including dizziness, chest pain, incontinence, swelling of the lips and tongue, wheezing, and stridor. Skin changes include flushing, pruritus, urticaria, and angioedema. In addition, the patient may be anxious and confused and have a sense of impending doom. 5. Identify an infections process. Lab results will be given, look at the lab results and figure out what is happening: if the WBC count is high, maybe there is an infection; if the WBC count is going too low after you start antibiotics  neutropenia Normal WBC: 5,000 to 10,000 mm3 6. What is the concentration of epinephrine that we give for anaphylactic shock? 1:1,000; if we give IV because there is no choice of giving it intramuscular then the concentration will be 1: 10,000 a. Remember: i. 1 mg epi is in 10ml (preloaded syringe)  usually we give 3-5 ml in anaphylactic shock if we are giving IV  0.3-0.5mg. ii. For ventricular fibrillation we give 1mg iii. For anaphylactic shock: 0.3-0.5mg iv. IV: 1:10,000; IM: 1:1,000 7. If someone has shock or cardiac failure especially in heart failure, what do we want to monitor frequently? Breath sounds (very important) because the heart starts to fail 8. African American has jaundice, where do you check for it? Hard palate 9. Select all that apply, S/S of hyperthyroidism, and hypoglycemia a. Hyperthyroidism: i. Exophthalmos (bulging eyes), ii. cannot sit in one place, hyperactivity, decreased attention span, emotional lability iii. Sweating, diaphoretic iv. Warm, sweaty, flushed skin with velvety-smooth texture v. High HR, tachycardia vi. losing weight, increased appetite vii. Diarrhea, viii. Anxiety, ix. Irritability, x. Insomnia, interrupted sleep xi. Fatigue, exercise intolerance xii. Tremors (place paper on hands and you will notice tremors), hyperreflexia, hyperkinesia, xiii. Intolerance to heat, xiv. Light or absent menstrual cycle xv. Libido initially increased in both men and women, followed by a decrease in libido as the condition progresses xvi. Vision changes, retracted eyelids, global lag xvii. Hair loss xviii. Goiter xix. Elevated systolic blood pressure and widened pulse pressure xx. Auscultation of thyroid gland  bruit b. Hypoglycemia: i. Cool, clammy skin ii. Tachycardia iii. Diaphoresis iv. Tachycardia v. Weakness, fatigue vi. Irritability, anxiety vii. Mild shakiness viii. Mental confusion ix. Sweating, diaphoresis x. Palpitations xi. Headache xii. Lack of coordination xiii. Blurred vision xiv. Seizure xv. Coma 10. Best way to measure to look at fluid volume, without using interventional technique like I&O: weight  accounts for insensible loss 11. In acute renal failure there are three phases: diuresis, oliguria, anuria a. In oliguria, how many ml/hr is the urine output? Less than 400 ml/24 hr b. AKI is comprised of four phases: ■ Onset – Begins with the onset of the event, ends when oliguria develops, and lasts for hours to days. ■ Oliguria – Begins with the kidney insult, urine output is 100 to 400 mL/24 hr with or without diuretics, and lasts for 1 to 3 weeks. Edema, elevated BUN, creatinine, and potassium; increased specific gravity; acidosis; heart failure, dysrhythmias ■ Diuresis – Begins when the kidneys start to recover, diuresis of a large amount of fluid occurs, and can last for 2 to 6 weeks. Urine output increased by diuresis of up to 4,000 to 5,000 mL/day, indicating recovery of damaged nephrons; decreased specific gravity; hypotension and fluid and electrolyte imbalances are a concern ■ Recovery – Continues until kidney function is fully restored and can take up to 12 months 12. If we give the patient thrombolytic, should we put her on bleeding precautions? Yes,  no razor blades a. Contraindications (active bleeding, peptic ulcer disease, history of CVA, recent trauma). b. Effects of bleeding (mental status changes, hematuria). c. Monitor for petechiae, ecchymosis, bleeding of the gums, nosebleeds, and occult or frank blood in stools, urine, or vomitus. d. Institute bleeding precautions (avoid IVs and injections – use smallest gauge needle in injection is needed, apply pressure for approximately 10 min after blood is obtained, handle client gently and avoid trauma). e. Instruct the client about measures to prevent bleeding (use electric razor and soft-bristled toothbrush, avoid blowing nose vigorously – blow gently without blocking with nasal passages, ensure that dentures fit appropriately). f. Instruct the client to avoid the use of NSAIDs. g. Teach the client to prevent injury when ambulating (wear closed-toes shoes, remove tripping hazards in the home) and apply cold if injury occurs. h. Apply ice to the area of trauma i. Avoid trauma to rectal tissue: do not take rectal temperature, do not administer enemas, administer well lubricated suppositories and with caution j. No flossing – floss gently (?) k. Avoid hard foods l. Avoid contact sports m. Do not take aspirin or aspirin containing medication.